Integrating Ambulatory Care Departments into a Hospital Quality Initiative through Magnet Principles

Problem statement and aims: A number of health systems have described the difficulties of ensuring coherent, network-wide approaches to patient safety across multiple care settings. A community healthcare organization undertook a system-wide quality initiative to reduce hospital-acquired infections and improve patient safety through a bathing and oral care initiative. It was agreed that all healthcare partners within the system would support the initiative in meaningful measurable ways. A number of hospital-based inpatient and ambulatory care departments across the system collaborated to work with the Magnet core committees and utilize the existing shared governance structure to contribute to patient safety. The challenge for the ambulatory care units included identifying measurable opportunities to participate in this very important quality initiative.

The aim of the ambulatory care project was to ensure patient education and pre-procedure readiness with a focus on education regarding the importance of daily bathing and oral care 2 to 4 times daily during hospitalizations.

Background: A system-wide healthcare quality project was initiated with the aim of decreasing hospital-acquired infections (CLABSI, CAUTI, HAPI) as well as near epidemic numbers of community acquired infections including C-Diff. The National Database of Nursing Quality Indicators (NDNQI) identified hygiene as the #1 missed inpatient care/treatment. The system-wide initiative is the first to be led by the nursing Magnet council and implemented using a shared governance approach that encompasses every department in the system.

Methods: The ambulatory care department worked with the four core Magnet committees to develop specific pre-procedure education and immediate pre-procedure oral and cleansing measures. The health system goal is greater than 75% compliance with once daily bathing and evidence-based oral care. The project will also include monitoring hospital-acquired infections rates and patient satisfaction related to bathing. Specific ambulatory care outcomes include: 1) provide education to ambulatory care patients pre-hospitalization on the importance of bathing and oral care prior to and during hospitalization, 2) educate ambulatory care patients immediately pre-procedure on the importance of pre-procedure bathing and oral care, and 3) ensure, when appropriate, pre-procedure hygiene and oral care is completed in the pre-procedural ambulatory care surgical areas.

The project timeline is as follows:
• 2019 Q1: conception and planning phase
• 2019 Q2: implementation
• 2019 Q3: data gathering
• 2019 Q4: continued data gathering and assessment
Conclusions: This project is currently in progress and we will have data to include if accepted to present at AAACN.

References
1. Huang, S. S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Heim, L., ... & Hayden, M. K. (2019). Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial. The Lancet.
2. Kanzigg, L. A., & Hunt, L. (2016). Oral health and hospital-acquired pneumonia in elderly patients: a review of the literature. American Dental Hygienists' Association, 90(suppl 1), 15-21.